Amazingly, roughly eighty percent of alcoholics smoke nicotine.[1]. As with nicotine, an inability to control use is the most glaring feature of dependency.
Has beer, wine, or liquor become central to daily life? Do you feel wanting and urges to drink? Have you noticed that you have gradually needed to drink a bit more over time in order to achieve the same effect?
Do you continue drinking despite alcohol adversely affecting your relationships, health, work, or life? Are you unable to drink in a controlled manner? Have you attempted to stop drinking? If so, do you experience the onset of withdrawal by the third day?
Remaining mindful that "denial" is huge with both nicotine and alcohol addiction, if not chemically dependent upon it, is it possible that you're dealing with problem drinking (alcohol abuse), that you've conditioned your mind to use too frequently or to drink too much?
As Joel sees it, "If a person says that they know that their drinking will cause them to take a cigarette and relapse back to smoking, and if they then take a drink and relapse, they are in effect problem drinkers, for they have now put their health on the line in order to drink."[2]
Is alcohol use your nicotine recovery roadblock? If so, while mental health professionals are generally reluctant to suggest simultaneous alcohol and nicotine recovery,[3], "research shows that smoking cessation does not disrupt alcohol abstinence and may actually enhance the likelihood of longer-term sobriety. Smokers in alcohol treatment or recovery face particular challenges regarding smoking cessation."[4]
A 2011 study reviewed 1,185 subjects who 9 years earlier had entered substance use treatment, 716 of whom had also smoked at the time. Among the 716 smokers, 14% had successfully stopped smoking within a year of substance use treatment.
The study found that those who had stopped smoking within a year of entering substance use treatment had 240% greater odds of both remaining abstinent from drugs, drugs plus alcohol, or alcohol alone within the past year, than those who had continued smoking.[5]
So, whether you vape, smoke, dip, or chew nicotine, what can you do if alcohol use and its inhibition diminishing effects have become factors preventing you from breaking nicotine's grip upon your mind and life?
The basic insights and skills needed to arrest any chemical dependency are amazingly similar. Recovering alcoholics schooled by quality treatment programs are already skilled in their use.
Research shows that while those with alcohol problems make fewer smoking cessation attempts, they are "as able to stop on a given attempt as smokers with no problems."[6]
Unfortunately, some alcohol recovery programs may have a tendency to actually destroy nicotine cessation attempts. "Many, if not most, alcohol recovery programs will inadvertently or very purposely push a new ex-smoker entering the program to smoke," writes Joel.
"Over the years I have in fact had actively drinking alcoholics in smoking clinics - people who made it abundantly clear that they knew they had drinking problems and smoking problems but wanted to treat the smoking first."
"I really do try to get them into alcohol treatment concurrently but cannot force them to do it. On more than one occasion I have seen the person successfully stop smoking, stay off for months and sometimes longer, and finally get into AA, only to be assigned a smoking sponsor who tells the person that he or she can't get off smoking and drinking at once, and who actually encourages the person to smoke again."
"Note the sequence here," says Joel. "The ex-smoker has been off nicotine for an extended time period but the smoking sponsor says that the person can't stop both at once. It is unfortunate that most alcohol and drug treatment programs just don't recognize smoking as another drug addiction."
Joel uses heroin to show the insanity of such advice. "You will not often see an AA sponsor say that you can't give up drinking and heroin at once, so if you have been off heroin for six months and now want to stop drinking, you should probably take heroin for a while until you get alcohol out of your system."[7]
Still, we are nicotine cessation educators only. Alcohol withdrawal syndrome is very real and can range from shakiness to the possibility of seizures, delirium tremens (the DTs), and death. While potentially life-threatening, treatment medications are available. It's why, if concerned about the possibility of co-dependency upon both nicotine and alcohol, enlist the assistance of your doctor and/or a quality alcohol treatment program.
In that alcohol diminishes inhibitions, it's the exception to the rule that we should try to quickly meet, greet, and extinguish all learned nicotine use associations.
We are each different. No one knows "you," your alcohol use patterns and history, or its effects upon your judgment and impulse control, better than you.
Generally, if not an alcoholic or problem drinker and able to control use, if you plan to continue alcohol use, obviously, it's important to allow yourself a few days to get your recovery legs under you and move beyond peak withdrawal before drinking. Even then, due to diminished inhibitions, the smart move is to devise and use strategies that break drinking alcohol down into more manageable challenges that present fewer potential crave triggering use cues.
Confronting alcohol-related crave triggers
As discussed in detail in Chapter 11, if a drinker, you've likely conditioned your brain to expect nicotine while consuming alcohol.
And even social drinkers should exercise extreme caution when attempting to extinguish alcohol-related nicotine use cues.
Use associations between alcohol and nicotine often involve multiple cues. We may have use cues associated with entering a drinking location, engaging in a drinking-related activity, sitting down, seeing alcohol containers, hearing ice cubes hit a glass or the sound of a bottle or can opening, picking up a drink, tasting that first swallow, or, as just explained, beginning to sense the onset of alcohol's inhibition diminishing effects.
Additional use cues may include encountering a drinking acquaintance, friend or another nicotine user, being around lots of other users, seeing ashtrays, cigarette packs and lighters within easy reach, seeing a cigarette machine or visible packs or cartons for sale behind the bar, or even something as simple as seeing a jug filled with free matches.
Use cues may be associated with engaging in conversation while drinking, or having conversation shift gears into debate or argument, as alcohol's inhibition diminishing effects begin to be felt.
Impaired judgment and diminished inhibitions may have aided in establishing cues associated with hearing music, feeling the beat, singing karaoke, dancing, playing games, flirting, fear, rejection, acceptance, partying, joy, sadness or beginning to feel drunk and turning to nicotine to stimulate the body's nervous system.
Encountering a conditioned use cue can cause a brief crave episode that may take up to 5 minutes. Remain mindful that time distortion is normal during withdrawal, and that panic may activate the body's fight or flight response, making time seemingly stand still. It's why looking at a clock or a watch is valuable in helping gain an accurate time perspective.
So, how do we tackle subconscious alcohol-nicotine use associations? Consider the benefit of learning to use alcohol while extinguishing your primary alcohol-nicotine use associations in the safest environment available (usually your home), away from other potential use associations.
Once able to drink alcohol without using nicotine, it's time to extinguish other nicotine-alcohol ties. Consider not using any alcohol during your first encounter with other potential alcohol-nicotine use situations, or limiting the amount of alcohol you consume so as to allow yourself greater conscious and rational control.
Consider drinking a bit slower than normal, spacing drinks further apart or drinking water, soda, or juice between alcoholic drinks. Combine your intelligence with baby steps. Have an escape plan and a backup plan and be ready to instantly deploy both.
Since half of all fatal vehicle collisions involve alcohol, if you do drink, make sure that driving isn't part of the plan.
References:
2. Spitzer, J, Can people quit smoking and still drink alcohol? Joel's Library, WhyQuit.com, October 2005.
3. Jacques D, et al, Quit smoking? Quit drinking? Why not quit both? Analysis of perceptions among Belgian postgraduates in psychiatry, Psychiatra Danubia, November 2010, 22 Supplement 1:S120-3.
4. Gulliver SB, et al, Smoking cessation and alcohol abstinence: what do the data tell us? Alcohol Research & Health, 2006 Volume 29(3), Pages 208-212.
5. Tsoh JY, et al, Stopping smoking during first year of substance use treatment predicted 9-year alcohol and drug treatment outcomes. Drug and Alcohol Dependence, April 1, 2011, Volume 114(2-3), Pages 110-1188.
6. Hughes JR, et al, Do smokers with alcohol problems have more difficulty quitting? Drug and Alcohol Dependence, April 28, 2006, Volume 82(2), Pages 91-102.
7. Spitzer, J, Can people quit smoking and still drink alcohol? Joel's Library, WhyQuit.com, October 2005.
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